No. 1: North Texas Specialty Physicians

Relevant, quality patient care relies on comprehensive clinical information available at the point of care. To fully transform its paper-based healthcare delivery system into an electronic and integrated care model, North Texas Specialty Physicians, an independent physician association based in Fort Worth, invested more than $10 million into the development of an interoperable health information exchange.

NTSP wanted to gather and use real-time patient information that could be parsed from multiple sources to provide faster, better and safer patient care, enhance physician communication and provide fiscally responsible care within one single sign-on application.

NTSP's HIE collects, communicates and distributes medical data to physicians on disparate electronic health-record applications, providing healthcare providers with real-time parsed clinical data at the point of care. It communicates with certified EHR systems through clinical documents called Continuity of Care Records, or CCRs. The system processes either the ASTM International standard CCR or the Health

Level 7-based Clinical Care Document, or CCD, which includes patient demographics, diagnoses, current and past medications, allergies, laboratory results, procedures and a list of patient providers. The interoperable EHR system automatically sends and receives clinical documents prior to the patient's scheduled visit.

The following is an example of how the clinical data in the system directly benefited and improved the outcome of a patient visit: A 64-year-old woman with primary biliary cirrhosis and concurrent alcohol abuse visited her NTSP specialist. She was not compliant with office-visit follow-up for two years and was manifesting jaundice and confusion, which prevented a reliable history. The physician accessed the HIE and was able to view recent emergency room visits, diagnoses, medication lists and other tests. The clinical information available during the visit proved invaluable in the assessment of the patient's medical status.

The HIE has substantially reduced medical errors, duplicated services and unnecessary hospital admissions by enhancing physician-to-patient communication, better disease management and improved administrative workflow.

Although the benefits of the HIE are maximized for interoperable EHR users, an EHR is not required to benefit from this system. NTSP physicians without an EHR access the exchange through a secure Internet portal and can view summary information, print CCRs, communicate with other physicians via secure messaging, order labs, e-prescribe and send electronic referrals in a Health Insurance Portability and Accountability Act-compliant manner.

The HIE is interoperable with seven hospitals, two national laboratory providers, two e-prescribing systems, two major radiology groups and three EHR applications. There are more than 1.4 million unique patients participating, generating 1.5 million CCR transactions per month.

NTSP's core business is managing risk for 25,000 capitated Medicare Advantage lives through payer contracts. This patient population generates healthcare expenses that total approximately $220 million annually. The HIE's sustainability is ensured in that the money saved on the improved management of our capitated lives produces a positive return on investment. As a payer and risk provider, the advanced healthcare delivery model enables NTSP to manage the capitated dollars more economically and in a way that creates more value for our members.

To continue to advance and improve patient care, NTSP is developing an electronic point-of-care quality application that will be integrated into the HIE. This application will provide healthcare providers with point-of-service prompts. In addition, it has the ability to perform advanced reporting for clinical quality measurements, clinical decision support, a triggered alerting system, population health management, data-mining and customizable reports that will help the provider achieve meaningful use and better monitor chronic conditions.

Our integrated healthcare delivery system is exactly what the government expects to implement across communities nationwide through the American Recovery and Reinvestment Act of 2009. Having an HIE that is advanced, interoperable and in production today, puts NTSP in a position to transform the care our patients receive and qualify for meaningful-use federal funds. In addition, NTSP is well-positioned to become a successful accountable care organization within the next few years.

Fowad Choudhry is the associate executive director of North Texas Specialty Physicians, Fort Worth. Thomas Deas Jr. served as president from 2003 until 2007 and is currently a board member.